Provider Demographics
NPI:1205008638
Name:TOBY P KRAVITZ
Entity Type:Organization
Organization Name:TOBY P KRAVITZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-649-2630
Mailing Address - Street 1:303 US ROUTE 5 S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-9508
Mailing Address - Country:US
Mailing Address - Phone:802-649-2630
Mailing Address - Fax:802-649-1709
Practice Address - Street 1:303 US ROUTE 5 S
Practice Address - Street 2:SUITE 4
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-9508
Practice Address - Country:US
Practice Address - Phone:802-649-2630
Practice Address - Fax:802-649-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT9341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty